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Unveiling the Potential of Tiered Networks: Navigating Savings and Disruption

By May 15, 2024No Comments
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As the healthcare landscape continues to evolve, organizations are seeking innovative strategies to manage costs without compromising the quality of care. Among these approaches, tiered networks have emerged as a compelling option, offering the promise of significant savings while reshaping the provider landscape. In this blog post, we delve into the nuances of tiered networks, exploring their adoption, effectiveness, and impact from various perspectives.

Tiered networks have gained traction across the healthcare industry, surpassing narrow networks in popularity. This model divides in-network benefits into two provider tiers, with the aim of achieving cost savings. The concept is straightforward: by incentivizing members to choose providers from the lower-cost tier, organizations can realize substantial discounts on healthcare services. In fact, tiered networks have been shown to drive discounts of up to 20%, although in competitive markets dominated by Tier 1 facilities, actual savings may be more modest.

However, despite the potential for savings, the implementation of tiered networks is not without its challenges. Concerns have been raised about the messaging surrounding these plans, particularly when the hierarchy of tiers is reversed. This experience has led to doubts among stakeholders about the efficacy of tiered networks and their ability to deliver on promised savings.

Nevertheless, accessing savings analysis for tiered networks is relatively straightforward, especially when armed with claims data. Results often closely align with projected savings, providing organizations with a clear understanding of the potential benefits.

Certain carriers stand out for competitive tiered network offerings, including select bundled pricing for services like joint replacements. Moreover, organizations may realize even greater savings by opting for a single high-performance network, as opposed to multiple in-network levels.

From an employee perspective, tiered networks may initially seem disruptive, but the potential for cost savings often outweighs any inconvenience. In fact, many employees report minimal disruption once they become accustomed to the new network structure.

It’s important to recognize that tiered networks contribute to the unique dynamics of our market, with their availability not guaranteed in every region. For example, Southeastern Pennsylvania (SEPA) currently lacks a tiered network option, highlighting the distinctiveness of the Central PA and Lehigh Valley healthcare landscape.

In conclusion, tiered networks represent a promising avenue for organizations seeking to rein in healthcare costs. While challenges exist, including messaging discrepancies and adoption rates, the potential for substantial savings and minimal disruption make tiered networks a compelling option worth exploring further. By leveraging comprehensive analysis and engaging stakeholders at every level, organizations can unlock the full potential of tiered networks in managing healthcare costs effectively.

Kim Miller

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